Power shift may mean more state money for children’s health care
It’s a delicate dance between state and federal governments. Somebody has to take the lead, and it’s almost always the fed because it carries the biggest purse. For the state, which would like a little more time on the dance floor, the last few months have been encouraging. President Bush brought in Tommy Thompson, who seems to understand the concerns of states, to head Heath and Human Services. And the sudden change in Senate leadership now tilts it toward expansion of Medicaid and children’s health coverage.
Sens. Edward Kennedy (D-MA), Jay Rockefeller (D-WV), and Olympia Snow (R-ME) have seized upon a new Commonwealth Fund report that advocates extending Medicaid and the Children’s Health Insurance Program (CHIP) to low-income parents in the hopes that it will get their children covered, too. The senators say they will prepare legislation that would allow more federal tax dollars to flow to the states for this kind of coverage. The senators say they hope, as a new Commonwealth Fund study indicates, that by expanding Medicaid and CHIP, more parents will be covered and they too will want to add their children to the coverage.
The Annie E. Casey Foundation in Baltimore has produced evidence that the past 10 years have seen an upturn in the outlook for children living in poverty. The foundation’s roundup of the conditions these children live in across the 50 states — the 2001 Kids Count Data Book — shows that times are better when it comes to major indicators such as the infant mortality rate, the child death rate, and the number of children living with parents who do not have full-time, year-round employment. Conditions were a little worse in the last decade for families with children headed by a single parent and the percentage of low birth weight babies.
The good news is a combination of circumstances, ranging from better health care policy to better medical technology.
"Child death rates are going down, and that’s partly due to medical services," William O’Hare, Annie Casey Foundation demographer, tells State Health Watch. "The health of children seems richer there than in any other area because of state-level measures and improvements in medical technology."
In the past 10 years, according to the foundation study, seven of 10 key measures of children’s well-being have improved, including the child poverty rate dropping 16.9% in 2000 from a decade high of 22.7% seven years ago. Teen births have dropped steadily, too, from 37 per 1,000 teens in 1990 to 30 per 1,000 teens in 1998. (See chart, below.)
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On the negative side, there are more low birth weight births and there are more children living in single-parent families.
Sitting at the top of the study’s list is New Hampshire, deemed the best when it comes to the well-being of children among states. Candice Leonard, director of policy analysis for the Children’s Alliance of New Hampshire in Concord, says it’s great to be No. 1, but she adds her state still has plenty of problems to overcome. Those problems, she says, cut across policy disciplines and directions.
"Our rate of increase is not that great compared to other states. We’re concerned about what’s gotten worse, particularly when it’s related to economics and poverty," Ms. Leonard tells SHW. "We face an education funding crisis. New Hampshire has no income tax. It relies on property taxes to fund education. . . . Because the state needs to fund education, it is taking money away from the general fund, away from social service. Health and education are all connected, in a sense."
Mississippi fared well in the study, but it also has its problems. The study shows the state ranks at the bottom for teen birth rates, but it made the most gains across the country in states fighting child poverty, jumping from No. 50 to No. 44. From 1990 to 1998, according to the study, the proportion of Mississippi’s children living in poverty dropped by 26%. As for the bad showing for low birth weight babies, Jane Boykin, president of the Forum on Children and Families in Jackson, MS, says state policy should redirect itself.
"We’ll see a big return on any investment in prenatal care," Ms. Boykin tells SHW. "Our first step should be to extend coverage for pregnant women under the Mississippi Health Benefits Plan."
The plan covers pregnant women with incomes at or below 185% of the federal poverty level. Ms. Boykin recommends removing all income limits and implementing a sliding scale copayment requirement at upper income levels. The cost of prenatal care is tiny compared to what the state, meaning taxpayers, ends up paying for the care for low weight, pre-term births. Better to pay the lower bill now than to be socked with a huge one later on, as has been the practice, Ms. Boykin adds.
The state’s public health and welfare chairman, Bunky Huggins, says legislators passed a bill in 2000 so that HMOs could offer care to low-income, expectant mothers. The state wants more federal dollars, he says, but the big problem is that the state needs to match the federal ante, and that is the biggest hurdle.
So despite gains in medical technology, which have contributed to the increased well-being of children in America, policy should be at the base of more improvements, according to Douglas Nelson, president of the Annie E. Casey Foundation,
"Based on the nation’s experience with the baby boom of the 1950s, it’s clear that this recent rise in American’s under-18 population will put heavy demands on our already struggling public education, child care and family-support systems," Mr. Nelson says. "If we are going to sustain the recent progress we’ve seen in conditions affecting kids in the U.S., we will have to do far more to keep pace with the needs of this larger and more diverse generation of American children. . . . The first decade of this millennium will be pivotal. Our policy and investment decisions for families in the next few years will determine whether we’ll build on the progress of the ’90s or see important gains eroded. "
(For more detailed information on the Annie Casey Foundation study, go to www.aecf.org/kidscount/kc2001.)
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